MEDICARE: CULVER CITY PSYCHOLOGICAL ASSOCIATES, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	PSY13838	CA
2	103TC0700X	Clinical Psychologist	PSY15514	CA

General Provider Information

NPI Number	:	1689684607
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CULVER CITY PSYCHOLOGICAL ASSOCIATES, INC.

Provider Business Mailing Address
First Line	:	PO BOX 2900
Second Line	:
City	:	CULVER CITY
State	:	CA
Zip	:	90231-2900
Country	:	US
Telephone Number	:	310-838-2738
Fax Number	:	310-838-2729

Provider Business Practice Location Address
First Line	:	5000 OVERLAND AVE
Second Line	:	8
City	:	CULVER CITY
State	:	CA
Zip	:	90230-4995
Country	:	US
Telephone Number	:	310-838-2738
Fax Number	:	310-838-2729

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. VALERIE WITHERSPOON
Credential	:	PHD, RN, CNS
Telephone Number	:	310-838-2738

Provider Enumeration Date	:	08/09/2006
Last Update Date	:	08/22/2020

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